Osteotomy Underprep in Diameter Overprep in Length

Due to low bone density associated with no bone graft after extraction and possible accessory nerve, osteotomy at #19 is underprep in diameter (3.5 vs. 4.0x8.5 mm), but overprep finally in length (3.5x10 mm) with 1 ampule of Lidocaine.  Insertion torque associated with 4.0 and 4.5 mm cortical taps and 4.5x10 mm implant (Fig.1) is between 30-55 Ncm.  Since the implant is covered by buccal and lingual bone associated with deep placement, no bone graft is conducted.  The lingual gingiva has minor laceration near the access.  Periodontal dressing is applied.  It remains in place a week postop due to retention associated with the healing abutment (Fig.2 *).  A long abutment is placed for restoration 4 months postop (Fig.3), increasing the chance of abutment screw loosening (as compared to immediate implant) if the abutment is incompletely seated.

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Xin Wei, DDS, PhD, MS 1st edition 10/08/2019, last revision 04/13/2020